Vol 22, No 4 (2016)

CLINICAL STUDIES

MULTIPLE MYELOMA OF THE SPINE: SURVIVAL, COMPLICATIONS, AND NEUROLOGICAL STATUS AFTER SURGICAL TREATMENT

Zaborovskii N.S., Ptashnikov D.A., Mikhaylov D.A., Smekalenkov O.A., Masevnin S.V.

Abstract

Purpose – to evaluate the survival, neurological status, and complications after surgical management of patients with multiple myeloma of the spine. Materials and methods. A retrospective study of 44 patients with multiple myeloma of the spine operated in Vreden Institute of Traumatology and Orthopedics was held in the period between 2000 and 2015. Patients underwent decompressive surgery with additional spinal instrumentation. following parameters were evaluated: demographic data, pain intensity, neurological deficit, survival, and complications after surgery. Results. Overall results showed efficiency of surgical management of spinal instability and neurological compromise due to multiple myeloma of the spine. The mean postoperative survival time was 63 months. A significant improvement in VAS scale and neurological function was observed in the study population after surgery. Postoperative VAS was 7.1 scores compared with 3.6 scores preoperatively (p = 0.021). Twenty nine of 31 patients improved their neurological status. Poor life expectancy was associated with neurological deficit both before and after surgery (p<0.0001). There were 28 postoperative complications. Most frequent complications were deep wound infection and adjacent degenerative disease. There was no survival difference in cohorts with and without complications (p = 0.942).> <0.0001). There were 28 postoperative complications. Most frequent complications were deep wound infection and adjacent degenerative disease. There was no survival difference in cohorts with and without complications (p = 0.942). Conclusion. Decompression surgery with additional instrumentation significantly decrease pain intensity and improve neurological function in selected patients affected by spinal myeloma with spinal instability. Severe neurological deficit influence on survival both before and after surgery. Survival did not depend on complications.

Traumatology and Orthopedics of Russia. 2016;22(4):7-15
pages 7-15 views

LOCAL APPLICATION OF TRANEXAMIC ACID IN KNEE REPLACEMENT

Pshenitsyna E.V., Zagrekov V.I., Malyshev E.E.

Abstract

The purpose of the study – assessment of the efficacy of local application of tranexamic acid in TKA and the choice of the optimal dosage. Materials and methods. 48 patients were included in open-prospective study and were randomized to one of four groups. In the first group tranexamic acid was used as intravenous bolus at the beginning of the operation at a dose of 15 mg/kg. Additionally, after the installation of the prosthetic components, the surgeon performed periarticular infiltration of soft tissue by tranexamic acid solution at a dose of 15 mg/kg. In the second group of patients tranexamic acid was used as 500 mg intravenous bolus before surgery, and 500 mg locally after installation of the prosthesis components. In the third group of patients received tranexamic acid once at the beginning of the operation at a dose of 15 mg/kg iv bolus. In the fourth group tranexam was used after surgery once at a dose of 10 mg/kg. Results. In the first group of patients were achieved statistically significant, 5-6 times, reduction of blood loss on drainage in comparison with other groups, where the volume of postoperative blood loss was not significantly different between groups. Also in the first group recorded the smallest decrease in hemoglobin at the 5th postoperative day compared to the third and fourth groups. Complications associated with the use of tranexamic acid were not revealed. Conclusion. The method of periarticular infiltration by tranexamic acid in combination with its intravenous use in knee joint replacement is an effective and safe method for reduction of post-operative blood loss.
Traumatology and Orthopedics of Russia. 2016;22(4):16-24
pages 16-24 views

THE TREATMENT OF INFECTIOUS COMPLICATIONS AFTER HIP REPLACEMENTV

Komarov R.N., Mitrofanov V.N., Novikov A.V., Korolev S.B.

Abstract

Purpose of the study – to estimate the effectiveness of periprosthetic infection of the hip using different modifications of spacers. Material and methods. The authors analyzed treatment outcomes of 168 patients with clinical and laboratory signs of infection after hip replacement. Patients were divided into two groups: 87 patients (control group) underwent a standard two-stage revision hip joint arthroplasty with a spacer; 81 patients (test group) underwent preoperative examination procedure suggested by authors that was the basis for future selection of surgical technique using various spacers and customized follow up treatment. Results. The authors observed in test group a marked reduction of microbial contamination of periprosthetic tissue: 1 month after spacer implantation the test group features four times less pathogens as compared to control group. Need for re-revision was decreased by 1.8 times, twofold decrease in need for spacer revision after secondary examination, 1,4 less duration of hospital stay and 1,8 less disability duration was observed as compared to outcomes in control group after standard treatment approach. Functional outcomes of patients in test group in 6 months after secondary examination in regard of infectious complication after hip replacement were characterized by better Harris Hip scores as compared to control group. 6-12 months after revision the patients of test group were 1.3 times less reporting limitations of functional activity, twice less using support means and 2.2 times less needed pain medication. Conclusion. Complex treatment that includes preoperative examination, evaluation of bone defect volume, algorithm of choosing the antibiotic spacer type and its implantation technique as well as customized postoperative follow up treatment was proved to be efficient and results in stable eradication of chronic suppurative inflammation.
Traumatology and Orthopedics of Russia. 2016;22(4):25-34
pages 25-34 views

BIOLOGICAL RESPONSE METHOD IN REHABILITATION OF PATIENTS AFTER HIP JOINT ARTHROPLASTY

Vasil’kin A.K., Shaparyuk S.I., Shevchenko S.B., Denisov A.O.

Abstract

Purpose – to develop a comprehensive physio- and functional treatment with biological response method to improve rehabilitation outcomes in patients after hip joint arthroplasty. Materials and methods. The study included 154 patients who underwent hip joint arthroplasty. All patients were divided in two groups – test group (82 patients) and control group (72 patients). In addition to conventional rehabilitation the patients of the test group underwent 10-12 procedures using biological response equipment. Outcomes were evaluated by clinical examination (VAS pain dynamics, goniometry), functional diagnostics (EMG), biomechanical examination (stability) as well as life quality assessment by SF-36. Patients were followed up to one year. results. In result of the study the authors observed regress in complaints and clinical symptoms in patients of both groups. VAS evaluation demonstrated that in the test group pain decrease was more significant (at 15-20% at various time stages), was reported earlier (5,0±0,9 days) and persisted during the follow up period. ROM increase of operated hip in the test group was 15-20% higher than in control group according to goniometry analysis. Patients of both groups demonstrated increased range and frequency of biopotential in examined muscles as well as a reduced displacement of gravity center of the body. However, a larger degree of above changes was observed in patients of the test group following biological response procedures that provide for exercise of affected muscles as well as for antagonistic muscles. Life quality improvement was faster in patients of the test group. Conclusion. The authors reported correlating results of clinical and biomechanical examinations, electromyography and life quality assessments that altogether prove efficiency and prospects of presented comprehensive rehabilitation treatment utilizing biological response method in patients after hip joint arthroplasty.
Traumatology and Orthopedics of Russia. 2016;22(4):35-44
pages 35-44 views

OUTCOMES OF PALLIATIVE ORTHOPEDIC SURGERY FOR HIP DISLOCATION IN PATIENTS WITH CEREBRAL PALSY

Bidyamshin R.R., Ryabykh S.O., Chibirov G.M., Popkov D.A.

Abstract

Introduction. Hip dislocation is the key problem in patients with severe cerebral palsy (GMFCS IV, V) older than 10 years that affects life quality and limits functional capabilities. In the present study the authors evaluated the efficiency of the proximal femoral resection arthroplasty (pfra) and valgus proximal osteotomy of the femur (VPOF) associated with femoral head resection for pain control, improvement of postural management, hygiene and verticalization with total weight-bearing and correction of accompanying orthopaedic deformities. Material and мethods. A retrospective study compared two groups of patients where PFRA (7 cases, 13 hips) or VPOF (14 patients, 23 hips) were performed. Level V of GMFCS was reported in 10 patients, and level IV of GMFCS – in 11 patients. The mean age at time of surgery was 15.3±3.9 y.o. PFRA was performed in 7 cases (13 joints) and VPOF – in 14 patients (23 joints). Results. The authors did not observe any difference between the methods in respect of pain control, postural management, comfortable sitting position and hygiene. The verticalization with total weight-bearing and life quality improvement was achieved only after PVOF with femoral head resection associated with simultaneous knee and foot deformity correction performed according to the principles of Single-Event Multilevel Orthopedic Surgery. Conclusion. Both palliative methods allow to control pain syndrome, to achieve satisfactory postural management, comfortable sitting position and hygiene. But only VPOF with simultaneous knee and foot deformity correction provides possibility to verticalize the patient with weight-bearing using different orthopedic devices.
Traumatology and Orthopedics of Russia. 2016;22(4):45-59
pages 45-59 views

THEORETICAL AND EXPERIMENTAL STUDIES

EXPERIMENTAL AND MORPHOLOGICAL ASPECTS OF FAILED TENDON AUTO- AND ALLOGRAFTS AFTER ACL RECONSTRUCTION IN EARLY POSTOPERATIVE PERIOD

Rybin A.V., Kuznetsov I.A., Rumakin V.P., Netylko G.I., Lomaya M.P.

Abstract

Purpose of the study – search for morphological cause of failure for free tendon auto and allografts after ACL reconstruction of the knee joint in early postoperative period during in vivo experiment. Materials and methods. Experiment included two groups of rabbits, each group consisting of 9 animals. In the first group the authors performed ACL autografting by semitendinous tendon harvested from operated limb. In the second group, ACL allografting was made by foot flexor tendon harvested earlier in rabbits excluded from present or other experiments after pretreatment and sterilization in modified Belyakov’s medium. Results. The major cause for failure of ACL tendon grafts after reconstruction in early postoperative period is the necrosis of intraarticular portion of auto or allograft on the 15th day after the procedure. In case of overexposure of the graft in early period the authors observed rupture along intraarticular portion or - more probable - along the demarcation area (serrated line) rather than graft slipping from bone tunnel with slackening. Intra-tunnel graft portion during first several days after the procedure became surrounded by granulated tissue in contrast to intraarticular portion that remained bare of such support. Conclusion. Comparative experimental and morphological study of two options of ACL reconstruction demonstrated a uniformity of alterations in dynamics with a certain delay in development of compensatory and adaptive processes after allografting. Necrosis (or homogenization) of intraarticular portion of auto or allograft is the cause for potential failure of ACL reconstruction in case of an extremely early and unjustified active rehabilitation.
Traumatology and Orthopedics of Russia. 2016;22(4):60-75
pages 60-75 views

MORPHOGENESIS OF KNEE HYALINE CARTILAGE DURING INTRAARTICULAR INJECTION OF PLATELET-RICH AUTOLOGOUS PLASMA AND/OR HYALURONIC ACID PREPARATION IN RATS WITH EXPERIMENTAL OSTEOARTHRITIS

Demkin S.A., Malanin D.A., Rogova L.N., Snigur G.L., Grigorieva N.V., Baydova K.V.

Abstract

According to current concepts, the influence of autologous platelet-rich plasma (PRP) and high molecular hyaluronates (HA) on the repair of hyaline cartilage during its inflammatory and degenerative changes has been insufficiently studied yet. The objective of the work was to evaluate the morphological changes in the structure of hyaline cartilage in experimental osteoarthritis after intra-articular injection of PRP and/or HA. Material and methods. The authors used 50 adult rats of Wistar line, weighing 250±2,2 g., distributed into five groups of 10 animals (two control and three experimental groups). An experimental gonarthosis was simulated on four groups of animals. Animals of the first experimental group received intra-articular injection of PRP, the second group – HA, the third – both PRP and HA. Results. No morphological signs of degenerative and inflammatory changes in the first control group were identified. Following osteoarthritis simulation the articular cartilage thinned to 121±20,4 microns (p<0,05) and the volume fraction of chondrocyte decreased to 1,2±0,6% (p<0,05). The authors observed an uneven coloration of collagen fibers with severe tinctorial properties disorder of the articular cartilage matrix. After the RPR introduction the authors observed tickening of the articular cartilage up to 275±18,9 micron (p<0,05) and the volume fraction of chondrocytes up to 18,4±2,0% (p<0,05). The contour of the cartilage surface became smoother with the formation of a cell-free zone. Collagen fibers demonstrated a uniform distribution, tinctorial properties of cartilage matrix in all areas were preserved, no signs of inflammation were noted. After HA introduction the authors observed thickening of the cartilage plate up to 264±21,3 microns (p<0,05) and the volume fraction of chondrocytes up to 11,6±1,2% (p<0,05). The surface of the cartilage featured uneven contours due to multiple areas of pulping. Uneven tinctorial properties of cartilage matrix, thickness and orientation of collagen fibres were retained. No signes of inflammation were observed. After the combined consecutive application of PRP and HA cartilage thickness increased up to 268±15,3 microns (p<0,05) and the volume fraction of chondrocytes increased up to 12,7±0,9% (p<0,05). Individual portions of pulping on the cartilage surface were observed. Tinctorial properties of the cartilage matrix were preserved; the focal uneven staining of collagen fibers in the basal zone was observed. No signs of inflammation were noted. Conclusion. During osteoarthritis simulation in knee joints of experimental Wistar line rats the authors observed severe structural changes in articular hyaline cartilage including complete destruction accompanied by vascular proliferation and granulomatous inflammation. Intraarticular injections of PRP, HA as well as PRP in combination with HA during the simulation of osteoarthrosis were accompanied by a decrease in the severity of degenerative and dystrophic processes and improval of tinctorial properties of articular cartilage matrix. Sole application of PRP or consecutive application of PRP followed by HA were observed as having the more significant reparative effect on articular cartilage as compared to HA.
Traumatology and Orthopedics of Russia. 2016;22(4):76-87
pages 76-87 views

INFLUENCE OF THE SKELETON HIERARCHICAL ORGANIZATION ON ELECTRONIC STATE OF IONS IN BONE MATRIX

Avrunin A.S., Pavlychev A.A., Doctorov A.A., Vinogradov A.S., Samoilenko D.O., Svirsky G.I.

Abstract

The authors suggested the 3D-superlattice (3DSL) model to describe the effect of coplanar assembly of the hydroxyapatite (HA) nanocrystallites on local electronic state of ions in mineralized bone. This model is based on the main structural and functional relationships between adjacent levels of the hierarchical organization of bone tissue. In the framework of the 3DSL model the authors predicted the distinct assembly-to-crystal red shift of the unoccupied electronic states located near the bottom of the conduction band in HA and dependence of this shift on the ratio of the thickness of the hydrated layer to the crystallite size. To check these predictions the experimental X-ray absorption studies of native bone are performed near the Ca2р1/2,3/2-, P2р1/2,3/2- и O1s edges. Comparison of the measured spectra with the known spectra of the reference compounds has confirmed appearance of the distinct assembly-to-crystal red shift. The observed effect is the ground for development of new diagnostic methods for bone status and imaging changes in the local electronic structure of bone tissue by using ultrasoft X-ray absorption spectroscopy and measuring the assembly-tocrystal shifts. The experimental data analysis proved the applicability of the 3DSL model for better understanding of the hierarchical organization of bone at nanolevel.
Traumatology and Orthopedics of Russia. 2016;22(4):88-97
pages 88-97 views

HISTOMORPHOMETRIC CHARACTERISTICS AND PATHOGENIC MECHANISM OF PERONEAL NERVE NEUROPATHY IN EXPERIMENTAL FRACTIONAL LOWER LEG LENGTHENING

Varsegova T.N., Schudlo N.A., Schudlo M.M., Stupina T.A., Emanov A.A.

Abstract

Purpose – to study histomorphometric characteristics and pathogenic mechanism of peroneal nerve neuropathy in experimental lower leg lengthening by one millimeter per day in four increments. Methods. The authors performed lengthening of lower leg in 12 adult mongrel dogs at 14-15% of initial length by Ilizarov technique. 28 days after the leg distraction, 30 days after its fixation in the device and 30 days after the Ilizarov fixator dismounting the authors withdrew the animals from the experiment. Peroneal nerve portions were examined using light microscopy, histomorphometry of the full-color images of the giant epoxy semifine sections stained with methylene blue and diamond fuchsin. Results. Planimetric investigation demonstrated 15% decrease (p<0.05) in the total area of nerve fiber bundles after distraction confirming transverse contraction of intrafascicular content. Fibrosis, increased cellularity of epineurium as well as the decrease in adipocyte number and size was observed in result of distraction and fixation. Neuropathy of the peroneal nerve was observed in one of the 12 animals – more than 80% of myelinated fibers demonstrated destructive changes, the large arteries of epineurium demonstrated obliterated lumina, part of arteries had necrobiotic changes in the cellular elements of the walls. In the remaining animals the proportion of the transformed myelinated fibers in the experiment time frame amounted to 6.0±1.4%, 4.3±1.3% and 4.2±0.4% (normally: 1.9±0.3%), no marked vascular damage was observed, the number of epineural vascular modules increased up to 6.0±1.5 (contralaterally – up to 4.0±1.6), the number of endoneural microvessels was increased at 35.5%, 10.9% and 38.9% (p<0.05) in respect of intact norm (141.8±8.7 per 1 mm2). Reduced proportion of capillaries with open lumina confirmed vasomotion disorder. The changes analysis in the distribution of myelinated fibers by diameter and mean size indicates the distinct axonal atrophy, deand re-myelinaton. The mean diameter of axons and myelin thickness remained respectively 7% and 14% below normal (p<0.05) in 30 days after the fixator dismounting. Conclusion. Good structural preservation of the majority of peroneal nerve fibers during leg lengthening in the manual fractural mode is ensured by integrity and hypervascularization of the nerve membranes. Axonal atrophy and hypomyelination observed in part of the fibers is associated with epineurium thinning due to decreased adipocytes content and their size. Histologically documented neuropathy was observed in one case of twelve along with lumina obliteration of main epineural arteries.
Traumatology and Orthopedics of Russia. 2016;22(4):98-106
pages 98-106 views

MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

DUAL MOBILITY ACETABULAR COMPONENT AS A WAY TO PREVENT HEAD DISLOCATION OF THE HIP

Shilnikov V.A., Baiborodov A.B., Denisov A.O., Efimov N.N.

Abstract

Prevention of femoral head dislocation is becoming one of the most important tasks in view of increased number of total hip replacement procedures throughout the world. The purpose of the present work is to acquaint the surgeons with possibilities and the first experience of dual mobility acetabular component application as the most up-to-date solution to prevent dislocation of the femoral head in primary or revision arthroplasties. The paper is based on the literature data and presents a critical analysis of the causes of femoral head dislocation during hip replacement. The authors considered historical aspects and the first outcomes of dual mobility use in the European and Western countries, as well as own positive clinical experience with dual mobility system during a study of 36 patients with an increased risk of femoral head dislocation.
Traumatology and Orthopedics of Russia. 2016;22(4):107-113
pages 107-113 views

CUSTOMIZED ACETABULAR COMPONENTS IN REVISION HIP ARTHROPLASTY

Kavalersky G.M., Murylev V.Y., Rukin Y.A., Lychagin A.V., Elizarov P.M.

Abstract

In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years). Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months). The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be widened to various orthopaedic centres and will undoubtedly improve the quality of treatment for such patients.
Traumatology and Orthopedics of Russia. 2016;22(4):114-121
pages 114-121 views

CASE REPORTS

BONE ALLOGRAFTING IN REVISION KNEE ARTHROPLASTY: HISTOLOGICAL CHARACTERISTICS OF STRUCTURAL ALLOGRAFTS 54 MONTHS FOLLOW UP

Kuliaba T.A., Kornilov N.N., Bovkis G.Y., Croitoru I.I., Rumakin V.P.

Abstract

Compensation of large bone defects by AORI third type classification is the most difficult problem the audit knee arthroplasty. In this situation, the surgeon have to choose between three possibilities: to use metal cones/sleeves, and, in cases with severely damaged metaepiphysis, to use structural allografts or oncological megaimplants. No doubt, it is interesting to follow the processes that are taking place with massive structural allografts implanted into the human body long time ago. This article presents the case study of the rheumatoid arthritis patient’s treatment with a severe lesion of the knee joint, subjected to repeated revision surgeries, last two of which are made with the use of massive structural allograft of femur. Morphological study of a massive distal femur allograft in 54 months after surgery showed that superficial ingrowth of connective tissue and blood vessels happens on the allograft’s border with its partial restructuring of the bone tissue at the border with the recipient bone. However, the most of allograft remains unchanged even after 54 months after surgery.
Traumatology and Orthopedics of Russia. 2016;22(4):122-130
pages 122-130 views

TRAUMA AND ORTHOPEDIC CARE

COMPARATIVE ANALYSIS OF MORTALITY FROM EXTERNAL CAUSES IN ST. PETERSBURG, NORTHWEST FEDERAL DISTRICT AND RUSSIAN FEDERATION

Vorontsova T.N., Luchaninov S.S., Cherny A.Z.

Abstract

The purpose of this study was to evaluate the mortality rate of St. Petersburg population from external causes in 2010–2015 in comparison with similar indicators for the Northwest Federal District and the Russian Federation. Materials and methods. The authors used the following data for analysis: annual long-term monitoring of St. Petersburg trauma services status conducted by coordination and methodological center of trauma and orthopedics; government reporting on mortality; data of Federal State Statistics Service (Rosstat); data of St.Petersburg Statistics Service (Petrostat); data of St. Petersburg Medical Information Analysis Center (MIAС); studies on mortality issues as well as methods of descriptive statistics. Results. From 2003 to 2014 St. Petersburg population mortality rate demonstrated a steady decline as well as generally in Russia. 2015 featured a slight increase in absolute number of deaths per year (+1.2%) in St.Petersburg, while the similar indicator across the Russian Federation was still declining (-5.9%). In 2015 mortality from external causes in St. Petersburg constituted 68 deaths per 100 thousand inhabitants, which is 1.6 times less than in the Northwest federal district (109.6 per 100 thousand inhabitants), and 1.7 times less than in the Russian Federation – 112 per 100 thousand population. In the overall mortality structure of St. Petersburg population the external causes have been consistently occupying third place within recent years. In 2015 the proportion of deaths from external causes in general mortality amounted to 5.7%. Conclusions. According to official statistics since 2000 in St. Petersburg the mortality rate from all the major external causes reduced gradually, as well as in the Northwest federal district and on the whole in Russia. Various national and regional programs that have been rolled out in Russia allowed to reduce by half the mortality of working age population from homicide and from suicide by almost 30% in men and 40% in women. The most reliable evaluation can be made by taking into account a consistent reporting data of overall traffic accidents mortality. In calculation of mortality rate from external causes there is a possibility to underreport injury and poisoning mortality rates described by the following ICD-10 codes: X40-X49, R95-R99, Z57, Z58, Z63, R54.
Traumatology and Orthopedics of Russia. 2016;22(4):131-145
pages 131-145 views

REVIEW

PERONEAL TENDON LESIONS IN ATHLETES (REVIEW)

Achkasov E.E., Sereda A.P., Repetyuk A.D.

Abstract

The authors analyzed scientific literature in respect of various issues in treatment of athletes with peroneal muscles lesions starting from 1987 till 2016. Key search and publications selection was made in PubMed and russian national electronic scientific library eLIBRARY. Peroneal tendons pathology is not the major but the underestimated cause of pain in lateral and hindfoot as well as of foot dysfunction which is difficult to distinguish from lesions of lateral ligaments of the ankle joint. Untreated lesions of peroneal tendons can result in chronic ankle pain and significant functional disorders. The purpose of the present paper is to improve the current comprehension of anatomy, to identify factors contributing to pathology, to perform diagnostic evaluation of peroneal tendons and to review current treatment options of such lesions.
Traumatology and Orthopedics of Russia. 2016;22(4):146-154
pages 146-154 views

SCIENTIFIC INFORMATION

XII CONGRESS OF THE RUSSIAN ARTHROSCOPIC SOCIETY WITH INTERNATIONAL SHARING DEDICATED TO XX ANNIVERSARY OF ITS FOUNDATION

Abstract

.

Traumatology and Orthopedics of Russia. 2016;22(4):155
pages 155 views

INDEX OF ARTICLES PUBLISHED IN 2016

Abstract

.

Traumatology and Orthopedics of Russia. 2016;22(4):156-158
pages 156-158 views

AUTHOR’S INDEX 2016

Abstract

.

Traumatology and Orthopedics of Russia. 2016;22(4):159
pages 159 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies